ABSTRACT:
Background: The
percentage of United States’
births delivered by cesarean section
has increased rapidly in recent years, even for women considered to be at low
risk for a cesarean
section. The purpose of this paper is to examine infant and neonatal mortality
risks associated with
primary cesarean section compared with vaginal delivery for singleton full-term
(37–41 weeks’
gestation) women with no indicated medical risks or complications.
Methods: National
linked birth and infant death data for the 1998–2001 birth cohorts
(5,762,037 live births
and 11,897 infant deaths) were analyzed to assess the risk of infant and
neonatal mortality for women with no
indicated risk by method of delivery and cause of death. Multivariable logistic
regression was used to model neonatal
survival probabilities as a function of delivery method, and sociodemographic
and medical risk
factors.
Results: Neonatal mortality rates were higher among infants delivered
by cesarean section
(1.77 per 1,000 live births) than for those delivered vaginally (0.62). The
magnitude of this difference
was reduced only moderately on statistical adjustment for demographic and
medical factors, and
when deaths due to congenital malformations and events with Apgar scores less
than 4 were excluded.
The cesarean/vaginal mortality differential was widespread, and not confined to
a few causes of death.
Conclusions: Understanding the causes of these
differentials is important, given the rapid growth in the
number of primary cesareans without a reported medical indication. (BIRTH 33:3
September 2006)
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